Spiritual Care Handbook on PTSD/TBI is a new 3-hour online CEU course that provides best practices for the provision of spiritual care to persons with post traumatic stress disorder and traumatic brain injury.
With the wars in the Persian Gulf, Afghanistan, and Iraq, a new generation of military veterans has arrived home, requiring appropriate and sensitive pastoral care. This course is based on a handbook written for the Department of the Navy by The Rev. Brian Hughes and The Rev. George Handzo, entitled Spiritual Care Handbook on PTSD/TBI: The Handbook on Best Practices for the Provision of Spiritual Care to Persons with Post Traumatic Stress Disorder and Traumatic Brain Injury. This manual begins by describing the criteria for posttraumatic stress disorder and traumatic brain injury. The handbook goes on to outline a theory of recovery, to describe the general stance of the pastoral counselor, and to provide guidelines for sensitivity to differences in religion, culture, and gender.
Referring to the empirical literature, specific pastoral interventions are described, including group work, meaning-making, spiritual care interventions, clinical use of prayer and healing rituals, confession work, percentage of guilt discussion, life review, scripture paralleling, reframing God assumptions, examining harmful spiritual attributions, encouraging connection with a spiritual community, mantra repetition, creative writing, sweat lodges, psychic judo, interpersonal therapy, and trauma incident reduction. Several other beneficial features include a description of seven stages of faith development and tips for self-care for the pastoral counselor. Course #30-66 | 2009 | 112 pages | 18 posttest questions
Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; by the National Board of Certified Counselors (NBCC) to offer home study continuing education for NCCs (Provider #5590); by the Association of Social Work Boards (ASWB Provider #1046, ACE Program); by the National Association of Alcoholism & Drug Abuse Counselors (NAADAC Provider #000279); by the California Board of Behavioral Sciences (#PCE1625); by the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); by the Illinois DPR for Social Work (#159-00531); by the Ohio Counselor, Social Worker & MFT Board (#RCST100501); by the South Carolina Board of Professional Counselors & MFTs (#193); and by the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).
What Customers Are Saying:
“I work with trauma survivors, who include returning veterans, their families, as well as non-military trauma survivors. I work from a Rogerian/mindfulness perspective,and having this background regarding pastoral counseling and working with PTSD/TBI will be very helpful in my practice.” – K.S. (Counselor)
Yesterday, the board of trustees of the American Psychiatric Association (APA) approved a set of updates, revisions and changes to the reference manual used to diagnose mental disorders. The revision of the manual, called the Diagnostic and Statistical Manual of Mental Disorders and abbreviated as the DSM, is the first significant update in nearly two decades.
Disorders that will be in the new DSM-5 — but only in Section 3, a category of disorders needing further research — include: Attenuated psychosis syndrome, Internet use gaming disorder, Non-suicidal self-injury, and Suicidal behavioral disorder. Section 3 disorders generally won’t be reimbursed by insurance companies for treatment, since they are still undergoing research and revision to their criteria.
So here’s a list of the major updates…
Overall Changes to the DSM
According to the American Psychiatric Association’s statement, there are two major changes to the overall DSM — the dumping of the multiaxial system, and rearranging the chapter order of disorders. Most clinicians only paid attention to Axis I and II, so it’s no surprise the Axis system was never a big hit. The current chapter order has always been a bit of a mystery to most clinicians, so it’s good to know there’s some thought going into the new order of chapters.
DSM-5’s 20 chapters will be restructured based on disorders’ apparent relatedness to one another, as reflected by similarities in disorders’ underlying vulnerabilities and symptom characteristics.
The changes will align DSM-5 with the World Health Organization’s (WHO) International Classification of Diseases, eleventh edition (ICD-11) and are expected to facilitate improved communication and common use of diagnoses across disorders within chapters.
Removal of multiaxial system:
DSM-5 will move to a nonaxial documentation of diagnosis, combining the former Axes I, II, and III, with separate notations for psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V).
Autistic disorders will undergo a reshuffling and renaming:
“[Autism] criteria will incorporate several diagnoses from DSM-IV including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder (not otherwise specified) into the diagnosis of autism spectrum disorder for DSM-5 to help more accurately and consistently diagnose children with autism,” according to an APA statement Saturday.
The rest of this update comes from the APA’s news release on the changes:
Binge eating disorderwill be moved from DSM-IV’s Appendix B: Criteria Sets and Axes Provided for Further Study to DSM-5 Section 2. The change is intended to better represent the symptoms and behaviors of people with this condition.
This means binge eating disorder is now a real, recognized mental disorder.
Disruptive mood dysregulation disorder will be included in DSM-5 to diagnose children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year.
The diagnosis is intended to address concerns about potential over-diagnosis and overtreatment of bipolar disorder in children. Will children now stop being diagnosed with bipolar disorder, which has been a recurring concern among many clinicians and researchers? We will see.
Excoriation (skin-picking) disorder is new to DSM-5 and will be included in the Obsessive-Compulsive and Related Disorders chapter.
Hoarding disorder is new to DSM-5.
Its addition to DSM is supported by extensive scientific research on this disorder. This disorder will help characterize people with persistent difficulty discarding or parting with possessions, regardless of their actual value. The behavior usually has harmful effects — emotional, physical, social, financial and even legal — for a hoarder and family members.
Pedophilic disorder criteria will remain unchanged from DSM-IV, but the disorder name will be revised from pedophilia to pedophilic disorder.
DSM-5 will maintain the categorical model and criteria for the 10 personality disorders included in DSM-IV and will include the new trait-specific methodology in a separate area of Section 3 to encourage further study how this could be used to diagnose personality disorders in clinical practice.
Posttraumatic stress disorder (PTSD) will be included in a new chapter in DSM-5 on Trauma- and Stressor-Related Disorders.
DSM-5 pays more attention to the behavioral symptoms that accompany PTSD and proposes four distinct diagnostic clusters instead of three. PTSD will also be more developmentally sensitive for children and adolescents.
Removal of bereavement exclusion:
The exclusion criterion in DSM-IV applied to people experiencing depressive symptoms lasting less than two months following the death of a loved one has been removed and replaced by several notes within the text delineating the differences between grief and depression. This reflects the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode beginning soon after the loss of a loved one.
Specific learning disorder broadens the DSM-IV criteria to represent distinct disorders which interfere with the acquisition and use of one or more of the following academic skills: oral language, reading, written language, or mathematics.
Substance use disorder will combine the DSM-IV categories of substance abuse and
substance dependence. In this one overarching disorder, the criteria have not only been combined, but strengthened. Previous substance abuse criteria required only one symptom while the DSM-5’s mild substance use disorder requires two to three symptoms.
The APA board of trustees also outright rejected some new disorder ideas. The following disorders won’t appear anywhere in the new DSM-5:
Parental alienation syndrome
Sensory processing disorder
Although clinicians are “treating” these concerns, the board of trustees felt like there wasn’t even enough research to consider putting them in Section 3 of the new DSM (disorders needing further research).
So there you have it. What do you think about these final decisions for the DSM-5?
Editor’s note: Dr. Charles Raison, CNNhealth’s mental health expert, is an associate professor of psychiatry at the University of Arizona in Tucson. He has not personally examined the suspect in the Afghanistan mass shootings, Robert Bales, but has used news accounts as the basis for his views.
(CNN) — Q: Sgt. Robert Bales has been accused of killing 16 Afghan civilians.He served three tours in Iraq before this and his lawyer says he may have been suffering from post-traumatic stress disorder or a traumatic brain injury. What’s the link between violence and those disorders?
A: Psychiatrists understand some types of aberrant behavior pretty well and can do things to help resolve it. But, unfortunately, in other instances — and often the most interesting ones — we can only mumble generalities that require no special expertise and that offer no hope for a diagnosis or treatment.
Staff Sgt. Robert Bales has been identified as the soldier accused of killing 16 civilians in Afghanistan.
Take the case of U.S. Army Sgt. Robert Bales, accused of massacring 16 Afghan men, women and children while they slept unprotected in their village.
The first thing a psychiatrist would want to know is whether the person who committed such a heinous act was psychotic at that time, meaning out of touch with agreed-upon human reality. Did he perform the killings as a result of deeply held false beliefs or in response to hearing voices commanding him to act? If yes, then although the tragedy remains, the psychiatric mystery is solved.
But at this point, although Bales has reportedly told his lawyer he remembers nothing about the night of the massacre, there is no evidence he was psychotic immediately before the killing spree. Nor do we have any evidence at this point that the killings were motivated by some larger political purpose, which might also explain, but certainly not justify, them.
So why would someone who had appeared normal to everyone around him suddenly commit such a hideous act?
Much has been made in the media about the fact that Bales was on his fourth deployment. Moreover, he had suffered mild traumatic brain injury in Iraq. Traumatic brain injury can cause a wide range of mental difficulties, from poor decision making and memory to increases in impulsive behavior, irritability, depression and personality change.
So how likely is it that Bales’ traumatic brain injury explains the accusation that he massacred 16 Afghan villagers? The answer is: not very likely.
Why? Consider, as alternative possible explanation, mania. Mania is often characterized by the sudden onset of bizarre, agitated behavior in public and it is not necessarily related to traumatic brain injury.
Traumatic brain injury almost never causes otherwise solid citizens to ruthlessly massacre men, women and children.
Thousands upon thousands of people develop severe manic episodes every year. Thousands upon thousands of service men and women have been multiply deployed and have suffered various levels of traumatic brain injury, and yet there is only one Bales. That is why it doesn’t fit very well. Mass murder is just about as rare in people with brain damage as in people without brain damage.
Note that I said “just about.” In fact, organic brain damage can be a cause of mass violence. Probably the most classic example of this in American history was the case of Charles Whitman, who went on a shooting spree from atop the University of Texas tower that resulted in the death of 16 people. Although he was under multiple stressors at the time of the incident, he was found to have a brain tumor in the “rage area” of his brain (i.e. the amygdala) upon autopsy.
In the case of Bales, if he is guilty of the massacre, his actions may eventually be found to be related to a clearly causative organic factor. But my clinical experience tells me not to bet on this. It happens, but pretty rarely.
When people behave in unexpected ways for no good reason, it often turns out that when the full story of their lives is understood, the behavior no longer appears as unexpected. That which is neither clearly linked to either a medical or psychiatric illness is very likely intertwined in a person’s longstanding personality.
So, I suspect that if 100 psychiatrists were told that a previously normal service person massacred 16 civilians and was neither medically impaired nor psychotic, the majority of them would immediately suspect that the person in question might not have been as normal across his life as initial reports suggested.
In fact, as more comes out about Bales this appears to be the case. It now appears that he was involved in fraudulent business dealings. What makes the case so strange, however, are the multiple contrasting reports of his remarkably caring and selfless behavior on numerous occasions and his status as something of a small town hero.
I seem to end many of my CNNhealth pieces with some type of comment about how unsatisfying our current level of psychiatric understanding is. This pieces, alas, is no different in this regard. Frankly, at this point nothing in Bales’ actions makes psychiatric sense. On the other hand, how many highly admired, hard-working, patriotic, caring small-town heroes are embroiled in financial fraud or may have other dark behaviors in their backgrounds?
Maybe the fact that Bales himself may not make sense is the best place for us to start in our understanding of the horrible events in Afghanistan.